At any age, adolescents with extreme obesity can benefit from bariatric surgery, according to a new study.
Findings from the NIH funded Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study indicated that younger adolescents — ages 13 to 15 — lost significant weight and most had metabolic comorbidities resolve with 5 years after surgery, according to Janey Pratt, MD, of Packard Children’s Hospital Stanford in Palo Alto, California, and colleagues.
So did those in the 16-19 age range, the group reported in Pediatrics.
Both age groups saw similar amounts of body weight lost 5 years after surgery: -22.2% reduction from baseline in BMI (95% CI -26.2% to -18.2%) in the younger group and 24.6% (95% CI -27.7% to -22.5%) in the older teens.
Quality of life also significantly improved for both age groups within only six months of undergoing bariatric surgery, with improvements maintained 5 years out.
Hypertension remission occurred at similar rates in the two age groups — 77% and 67% among younger and older adolescents, respectively. Remission of dyslipidemia was seen in 61% of younger adolescents and 58% of older adolescents at year 5.
Although baseline prevalence of type 2 diabetes was relatively low across the total cohort — with only seven cases in younger adolescents and 22 cases among older adolescents — upwards of 80% were able to achieve remission five years out of surgery, though it was slightly less likely in the younger group (relative risk 0.86, 95% CI 0.74-0.99, P=0.046).
When it came to nutritional abnormalities — a common after-effect from bariatric surgery — younger adolescents tended to fare better. Rates of ferritin, transferrin, vitamin B12, and vitamin A elevations increased in both age groups during follow-up, but the younger group was less likely to show elevated transferrin (prevalence ratio 0.52, 95% CI 0.27-0.99, P=0.048) and depressed vitamin D (PR 0.80, 95% CI 0.65-0.98, P=0.034) versus older adolescents.
Mean baseline BMI was 53.1 in the 13- to 15-year-olds (n=66) and 52.4 in those ages 16-19 (n=162). Patients were recruited from five U.S. clinical centers and underwent Roux-en-Y gastric bypass surgery or vertical sleeve gastrectomy. This included 66 younger adolescents between the ages of 13 to 15, and 162 older adolescents between the ages of 16 to 19.
Reflective of the general bariatric surgery population, the cohort was 75% female and 72% white.
Pratt told MedPage Today that the overall results were largely as expected. “The study confirms that children who are younger do not have significantly different outcomes and may have better compliance with vitamins than the older group,” she said.
The study was motivated by uncertainty over whether outcomes may differ by age, she said. “In my own practice, my impression is that patients who are younger than 16 tend to do better than patients in the transition from high school to college,” she explained.
“The data set does not go as young as my own patient population,” Pratt added. “However, it can begin to give us the opportunity to explore the question.”
She also pointed out the importance of both age groups having similar baseline BMIs in the study, indicating that younger children are failing to be referred for bariatric surgery until their BMI is far above the 95th percentile.
“Early referral to a comprehensive obesity treatment program that includes bariatric surgery is the key to success for treating children with a BMI over the 95th percentile, regardless of age,” Pratt said.
She stressed that severe obesity is best treated with bariatric surgery: “Diet and exercise counseling are not considered adequate treatment for children with obesity.”
This was reflected in a 2019 policy statement from the American Academy of Pediatrics (AAP), which stated that although lifestyle and medication treatment can yield short-term benefits, “no studies to date demonstrate significant and durable weight loss [with nonsurgical therapy] among youth with severe obesity.”
The AAP also said that surgery remains underused in teens, as many patients don’t have access to this treatment despite studies showing that it is both safe and effective.
The study was mainly funded by the National Institute of Diabetes and Digestive and Kidney Diseases.
Ogle and co-authors reported no disclosures.